As more states consider large-scale restrictions on e-cigarette sales, it’s important for all of us to step back and ask, what are we trying to accomplish? Ushering in a new form of tobacco—one that is widely acknowledged to be at least 95 percent safer than combustible cigarettes—is certainly not without its problems, but if done correctly, many smoking-related illnesses and deaths that are so pervasive will be a thing of the past.
Of course, these products—e-cigarettes—are not meant for adolescents. To be clear, developing brains are affected by every experience, good and bad, that comes their way. But the stress and reward systems that work in tandem to keep us moving forward are particularly affected by drugs of abuse during our adolescence. It’s laudable to craft policies to minimize this impact, but when these policies fail to consider the problems of smoking and nicotine in their entirety, public health could take several steps backwards.
Smoking rates are declining overall, but some are left behind
If we are to develop policy that helps people move away from combustible cigarettes, we must recognize that cigarettes are here to stay, unequivocally and emphatically. We know that cigarettes are the most dangerous form of tobacco—they’re called cancer sticks for a reason— and we know that people, despite being aware of the dangers, still pick up the habit and have a hard time quitting once the habit is formed. Knowing that some people still gravitate towards cigarettes despite their health effects and that cigarettes are extremely protected from bans means that solutions other than prohibition must be considered.
The good news is that smoking rates are declining and have been since the mid ‘90s. Smoking among high schoolers is the lowest it has ever been, and there are many good policies, such as advertising bans, indoor smoking bans and even flavored cigarette bans that have contributed to this. But many populations have been left behind. For example, adults with only high school degrees are nine times more likely to smoke than those with graduate degrees, and adults living at the poverty level are three times more likely to smoke than those with wealth. More disappointing is that people in populations with disproportionate smoking rates want to quit at the same rate as other populations—about 70 percent try—but are only half as successful. Clearly, there’s a disconnect between encouraging people to quit and empowering disadvantaged populations to quit successfully.
E-cigarettes should be part of the solution
It may seem odd, but policymakers in the United States ought to consider other tobacco products as part of the solution rather than the problem, and there is precedence for this. Recognizing the incredibly low successful-quit rates of traditional methods and understanding that e-cigarettes are much safer than their combustible counterparts, the United Kingdom’s National Health Service encourages a harm reduction approach to smoking cessation, and has even opened vape shops in two of its hospitals. Skeptical acceptance of this turned enthusiastic once the UK saw the results: accelerated quitting rates for combustible cigarettes, evidence of limited impact on bystanders and improved health outcomes for people who switch.
To make this work, people have to be willing and able to switch. We have countless examples demonstrating that people are only willing to change when they see value in doing so. Making cities more walkable and providing public transportation decreases congestion from cars, and allowing people to use SNAP benefits at farmers markets encourages them to eat healthier.
When it comes to switching from a deadly product like cigarettes to a much safer one like e-cigarettes, flavors provide added value. Non-tobacco e-cigarette flavors help smokers transition from combustible cigarettes, and data suggests that while current smokers are partial to the flavor of traditional tobacco, former smokers prefer fruit or sweet flavors. Moreover, it has been demonstrated that e-cigarette users who use non-tobacco flavors, including menthol and non-menthol sweet flavors, are more likely to switch from combustible cigarettes completely than those who choose tobacco flavors.
If it’s possible that flavors can make smokers willing to switch, policymakers and regulators should allow them to remain accessible. It might be politically expedient to ban flavors or e-cigarettes entirely in the interest of protecting adolescents who may be drawn to them, but it should be noted that prior smoking and parental or peer use are by far the strongest predictors of adolescent use. We should ask ourselves: Is it right to ban a largely successful quitting tool at the expense of people who benefit from it? Policymakers need to recognize that not all tobacco products are created equally, and it doesn’t make sense to prohibit and overly restrict safer alternatives when fatal ones are cemented in the landscape of our laws, economy and culture.